Provider Demographics
NPI:1477533206
Name:BERRY, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ANSLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1640
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:
Practice Address - Street 1:134 ANSLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1640
Practice Address - Country:US
Practice Address - Phone:706-864-8385
Practice Address - Fax:706-864-5073
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047295207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000825448AMedicaid
GA0400253OtherUNITED HEALTHCARE
GA110222128OtherRR MEDICARE-GRP # CC4177
GA000825448AMedicaid
GA10045369OtherAMERIGROUP
GA52702282OtherBCBS
GA331607OtherCIGNA